| NPI | 1316406986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5223) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-03-13 |